Evaluation of intestinal tuberculosis by multi-slice computed tomography enterography

Zhao, Jing; Cui, Min; Chan, Tao; Mao, Ren; Luo, Yanji; Barua, Indira; Chen, Minhu; Li, Zi Ping; Feng, Shi Ting

doi:10.1186/s12879-015-1325-x

Cited by 18 publications

(21 citation statements)

References 30 publications

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“…Systemic toxic symptoms of TB including fever, malnutrition, weight loss and night sweats, were often associated with complications such as intestinal obstruction and intestinal perforation. Unfortunately, there were more cases (24.7%) of intestinal perforation in the current study, than in earlier studies (1.2–13%) , probably due to the poor initial diagnosis rate and delayed treatment.…”

Section: Discussioncontrasting

confidence: 86%

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Intestinal tuberculosis: clinico‐pathological profile and the importance of a high degree of suspicion

Cheng

Zhang

et al. 2018

Tropical Med Int Health

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Summary Objectives Intestinal tuberculosis (ITB) remains prevalent and a big health hazard in China. The aim of this study was to retrospectively analyse its clinico‐pathological features. Methods Retrospective study of 85 consecutive ITB patients in two tertiary hospitals in East China. Relevant clinical, laboratory examination, radiological, endoscopic and histopathological features of ITB were recorded. Results The mean age was 37.3 ± 16.0 years; 56 patients (65.9%) were male. 67.1% had ITB secondary to pulmonary tuberculosis. The overall median length of hospital stay was 28 days and was significantly longer in patients with intestinal complications (P = 0.003) and malnutrition (P = 0.042). Abdominal pain (88.2%) and weight loss (75.3%) were the commonest symptoms. The positive rate of the purified protein derivative (PPD) test was 88.2%; of the T‐spot, 85.7%. Histopathology revealed caseating granuloma in 70.6% and caseating necrosis in 24.7% of patients. The most commonly affected sites were the ileocecal valve (56, 65.9%), terminal ileum (40, 47.1%) and caecum (33, 38.8%). Only 17 (20%) patients were initially diagnosed as ITB, the other 68 patients were misdiagnosed. Six patients with caecum tuberculosis were misdiagnosed as appendicitis, four of whom had improper surgical procedures followed by post‐operative intestinal fistulas; two died due to MODS. Conclusions Diagnosis of ITB is often misdirected and delayed, which may lead to inappropriate treatment and high mortality. High diagnostic suspicion is necessary for patients with unexplained abdominal complaints. Diagnosis is not easy but could benefit coexisting pulmonary tuberculosis, T‐spot, CT imaging, colonoscopy, pathological features, acid‐fast bacilli and response to anti‐tuberculosis therapy (ATT).

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Section: Discussioncontrasting

confidence: 86%

“…The clinical manifestations of ITB are non‐specific and highly homogeneous to malignancy or other inflammatory bowel disease . For instance, both ITB and Crohn's disease (CD) are presenting as chronic abdominal pain, weight loss, mucosal ulcer and intestinal stenosis.…”

Section: Introductionmentioning

confidence: 99%

Intestinal tuberculosis: clinico‐pathological profile and the importance of a high degree of suspicion

Cheng

Zhang

et al. 2018

Tropical Med Int Health

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“…Prior to scan, patients ingested a total of 1600~ 2000 mL of 2.5% mannitol solution in 400–500 mL aliquots every 15 min, and administered 20 mg of anisodamine intramuscularly. For achievement of adequate entire colon distension, colon retention enema with 300~ 500 mL of 2.5% mannitol was performed before CT scan [ 12 , 13 ]. Patients were scanned using Toshiba Aquilion 64-detector row CT from diaphragmatic top to ischial tuberosity.…”

Section: Methodsmentioning

confidence: 99%

CT Enterography score: a potential predictor for severity assessment of active ulcerative colitis

Jia

Yang

et al. 2018

BMC Gastroenterol

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BackgroundEvaluate the possibility of CT enterography (CTE) score system as a predictor in assessing active ulcerative colitis (UC) severity.MethodsForty-six patients with active UC with CTE and colonoscopy were enrolled. Based on modified Mayo score, patients were divided into three groups: mild (n = 10), moderate (n = 17) and severe (n = 19). A cumulative CTE score was calculated in each patient and its correlation with modified Mayo score was analyzed. The optimal cutoff values of CTE score were determined by receiver operating characteristic (ROC) curves analysis.ResultsSignificant between-group differences were observed in CTE spectrums of mucosal bubbles, mural stratification, loss of haustration, enlarged mesenteric lymph nodes and engorged mesenteric vessels (P < 0.05). The cumulative CTE scores were significant difference between three groups (CTE score:4.9 ± 2.3, 7.6 ± 2.6, and 10.9 ± 2.0, respectively, P < 0.01). The cumulative CTE score showed a positive correlation with modified Mayo score (r = 0.835, P < 0.05). The optimal cut-off value for CTE score predicting moderate and severe UC was 9.5 (area under the curve [AUC]:0.847, sensitivity:78.9%, specificity:82.4%).ConclusionDisease severity assessment by CTE score demonstrates strong positive correlation with severity established modified Mayo score. CTE score system maybe a potential predictor for active UC severity assessment.

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“…TB remains controversial. Under this condition, a more practical way to diagnose ITB is to evaluate the responses of diagnostic ATT in patients with suspected ITB symptoms and endoscopic manifestations, which has become a widely-used method for ITB diagnosis [10–12]. With regard to therapy, the standard course of ATT can be as long as 6 to 12 months.…”

Section: Introductionmentioning

confidence: 99%

The potential role of CT enterography and gastrointestinal ultrasound in the evaluation of anti-tubercular therapy response of intestinal tuberculosis: a retrospective study

Zhu

et al. 2019

BMC Gastroenterol

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Background Accurate evaluation of anti-tubercular therapy (ATT) responses is crucial for both diagnosis and treatment of intestinal tuberculosis (ITB). Little is known about the role of cross-sectional imaging techniques in ITB follow-up assessment. We aimed to investigate the accuracy of cross-sectional imaging modalities, CT enterography (CTE) and gastrointestinal ultrasound (GIUS), in the evaluation of ATT responses in ITB patients. Methods Patients diagnosed with ITB and followed up by CTE and/or GIUS were retrospectively searched in the databases. Clinical, imaging, laboratory and endoscopic data were collected at baseline and the first follow-up visit. Responses were graded as good, partial and no response based on protocols described in the literature and by our institution. CTE evaluation was based on changes in the lesion area, mural thickness, enhancement patterns and lymph nodes, while GIUS evaluation was based on changes in bowel wall morphology and the Limberg score. Clinical evaluation was used as the gold-standard evaluation method, which was determined by a comprehensive impression of endoscopic changes along with symptomatic improvement and laboratory tests, with imaging results masked. Results Twenty patients with ITB were enrolled in our study. The first follow-up time was from 2 to 12 months (average 6 months). According to the gold standard evaluation, 11 patients were evaluated as having a good ATT response, while 9 had a partial response. A total of 18 patients were followed up by CTE, while 7 were followed up by GIUS, depending on medical and/or financial considerations. The accuracy of CTE and GIUS was 83% (15/18) and 85.7% (6/7), respectively. The sensitivity, specificity, PPV and NPV of CTE were 88.9, 77.8, 80 and 87.5%, respectively. Moreover, the sensitivity, specificity, PPV and NPV of GIUS were 100, 50, 83.3 and 100%, respectively. By combining the results of CTE and GIUS results, the overall accuracy was 90%, with sensitivity and specificity of 91.7 and 87.5%, respectively. Conclusion To our knowledge, this is the first study exploring the accuracy of the cross-sectional imaging modalities CTE/GIUS in the evaluation of ATT responses. Our results indicated their promising application prospect in clinical practice as a non-invasive and cost-effective approach. Electronic supplementary material The online version of this article (10.1186/s12876-019-1030-0) contains supplementary material, which is available to authorized users.

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Evaluation of intestinal tuberculosis by multi-slice computed tomography enterography

Cited by 18 publications

References 30 publications

Intestinal tuberculosis: clinico‐pathological profile and the importance of a high degree of suspicion

Intestinal tuberculosis: clinico‐pathological profile and the importance of a high degree of suspicion

CT Enterography score: a potential predictor for severity assessment of active ulcerative colitis

The potential role of CT enterography and gastrointestinal ultrasound in the evaluation of anti-tubercular therapy response of intestinal tuberculosis: a retrospective study

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